by Maddy Patten, Firefighter/EMT-B
It’s estimated that up to 10% of medications given in the prehospital setting are given in error (Vilke). Whether that be a medication given at the wrong dose or just the wrong medication in general, these mistakes do happen and while research shows that mistakes happen for a number of reasons, we know that the reasons are all preventable. Industry changes and improvement don’t happen overnight, and it’s going to take work and training from us providers, but the OneDose™ Protocol Management Tool and OneWeight™ Patient Scale from Hinckley Medical offer solutions to prevent providers from making medication errors.
One reason providers make errors is lack of training and proficiency (Wang). This problem is an easier one to fix as all we have to do is train more. Hinckley Medical is doing their part to help providers become more proficient in their protocols with special features in OneDose. For example, through the app, training departments can send out protocol quizzes to providers to familiarize themselves with new protocols, solidify existing protocol knowledge and reveal which protocols should be trained on. Departments can also use the app during training scenarios and then to review their performance. By identifying these errors in training, we can fix them and train on them more with the ultimate goal of eliminating them on calls.
Another leading cause of prehospital medication errors is stress and cognitive overload. As helpful as training is, we know that no training scenario will ever fully capture what we see, hear and feel on high-acuity calls, and therefore we’ll never be able to recreate the true stress we feel in the moments when we’re actually administering medication. A study done on paramedics in high-stress scenarios versus low-stress scenarios showed 13% less accuracy in medication calculations in high-stress scenarios (LeBlanc). That’s bad news for us providers, as most critical medications are given during high-stress calls, but OneWeight and OneDose work together to reduce provider cognitive overload and create calm amidst the chaos of a call. Once the patient lays down on the cot, the OneWeight scale sends the weight to the OneDose app, immediately generating all of the proper medication doses for that patient based on your district’s protocols. No more guessing or calculations, just clarity.
Research has also shown us that emergency medication errors don’t only happen during prehospital treatment, but also happen as a result of inefficient or inaccurate handoffs from prehospital providers to hospital staff (Institute of Medicine). This brings us to another helpful feature from OneDose, the time-stamped call log. Not only is this convenient when writing reports, but it’s critical when it comes time to give a clean, concise handoff to the ED staff. Visualize what it’s like as a provider bringing in a trauma alert or a patient who has just achieved ROSC: the patient is still in critical condition, time is of the essence, and you have a very limited window to give an accurate report to a room full of multiple doctors of different specialties who are all anxious to get working on their new patient. Now imagine being able to reference your tablet and see the exact log of all the interventions you made, down to the doses and sizes, all in chronological order. It’s a complete roadmap of your call and a perfect outline for your handoff. That efficient communication is going to gain providers the respect of the receiving doctors as well as set patients up for better care.
No matter how advanced EMS technology becomes, it’s ultimately up to us as providers in our continuous quality improvement efforts to identify our errors and train to improve them so that they don’t happen again. Luckily, we now have a set of EMS solutions from Hinckley Medical to use as an aid in training and as a tool on calls, all in the name of better patient care.
Sources:
Institute of Medicine (IOM). “Emergency Medical Services: At the Crossroads.” National Academies Press, 2007.
LeBlanc VR, MacDonald RD, McArthur B, King K, Lepine T. Paramedic performance in calculating drug dosages following stressful scenarios in a human patient simulator. Prehosp Emerg Care. 2005 Oct-Dec;9(4):439-44. doi: 10.1080/10903120500255255. PMID: 16263679.
Vilke GM, Tornabene SV, Stepanski B, et al. Paramedic Self-Reported Medication Errors. Prehospital Emergency Care, 2007;11(1):80-84.
Wang HE, Yealy DM. Out-of-Hospital Endotracheal Intubation: Where Are We? Annals of Emergency Medicine. 2006;47(6):532-541